Provider Demographics
NPI:1477702934
Name:CAPPIE BAKER, DDS, MS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CAPPIE BAKER, DDS, MS, A PROFESSIONAL CORPORATION
Other - Org Name:CB ORTHODONTICS DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAPPIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-523-2161
Mailing Address - Street 1:20930 BONITA ST
Mailing Address - Street 2:SUITE X
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3680
Mailing Address - Country:US
Mailing Address - Phone:310-523-2161
Mailing Address - Fax:
Practice Address - Street 1:20930 BONITA ST
Practice Address - Street 2:SUITE X
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3680
Practice Address - Country:US
Practice Address - Phone:310-523-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB325311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty